System and method for teaching a surgical procedure

ABSTRACT

A method of teaching a surgical procedure includes transmitting a first video, from a first location to a second location remote from the first location, of a surgeon in an operating room performing the surgical procedure on a patient with at least one surgical instrument. The method also includes transmitting a second video, from the first location to the second location, of the surgical instrument during the surgical procedure, annotating the second video with at least one annotation, and transmitting, from the first location to the second location, the at least one annotation overlaid on the second video.

CROSS-REFERENCE TO RELATED APPLICATION(S)

The present application claims priority to and the benefit of U.S.Provisional Application No. 62/810,838, filed Feb. 26, 2019, and U.S.Provisional Application No. 62/958,064, filed Jan. 7, 2020, the entirecontents of both of which are incorporated herein by reference.

BACKGROUND 1. Field

The present disclosure relates generally to systems and methods forteaching a surgical procedure to remotely located individuals.

2. Description of Related Art

Many surgical procedures, such as shoulder arthroscopy, requirespecialized training and expensive equipment, which are barriers toadoption of these surgical procedures in developing countries such asHaiti, Cuba, and Romania. As a result, the utilization of resources toteach these surgical procedures in developing countries is limited. Forinstance, in developing countries, arthroscopic surgical skills are notoften emphasized in training programs and, in particular, shoulderarthroscopic skills may not be taught. Accordingly, less efficacious butmore accessible treatment options are often chosen in developingcountries. For instance, an individual suffering a shoulder dislocationmay be treated non-operatively with immobilization even though thepatient would benefit more from arthroscopic repair. As a result,patients in developing nations are more likely to have recurrentinjuries, which will reduce their functional status and increasedisability and time out of work.

Additionally, many surgical procedures, including arthroscopy, havetraditionally been taught to residents or other surgeons throughone-on-one in-person guided training in the operating room. Whenone-on-one in-person training is not available, simulators have beenused to increase the availability of exposure to arthroscopy training.However, these simulators have significant limitations and cannot bedefinitively linked to improvement in arthroscopy skills in theoperating room.

SUMMARY

The present disclosure is directed to various embodiments of a method ofteaching a surgical procedure. In one embodiment, the method includestransmitting a first video, from a first location to a second locationremote from the first location, of a surgeon in an operating roomperforming the surgical procedure on a patient with at least onesurgical instrument, and transmitting a second video, from the firstlocation to the second location, of the surgical instrument during thesurgical procedure. The method also includes annotating the second videowith at least one annotation, and transmitting, from the first locationto the second location, the at least one annotation overlaid on thesecond video.

The first video may be an extracorporeal video of the surgeon and atleast a portion of the patient, and the second video may be anintracorporeal video of the surgical instrument inside the patient.

Transmitting the first video, the second video, and the at least oneannotation overlaid on the second video may be performed by transmittinga single video stream including the first video, the second video, andthe at least one annotation overlaid on the second video.

The method may also include displaying the second video on a display inthe operating room.

The method may further include displaying on the display in theoperating room at least one annotation transmitted from the secondlocation.

Annotating the second video may be performed with an input deviceconnected to the display in the operating room, and the input device maybe, for example, a mouse, a stylus, a keyboard, a touch screen, orcombinations thereof.

The at least one annotation may include a shape, a symbol, a graphic,text, or combinations thereof.

The method may also include transmitting, from the first location to thesecond location, audio captured by a microphone in the operating room,and/or generating audio, from a speaker in the operating room, capturedby a microphone at the second location.

Transmitting the first video may be performed synchronously withtransmitting the second video, and transmitting the first video and thesecond video may be performed in real-time.

Annotating the second video may be performed by an individual other thanthe surgeon.

According to another embodiment of the present disclosure, the method ofteaching a surgical procedure includes transmitting a first videostream, captured by a first video camera in an operating room, of asurgeon performing the surgical procedure with a least one surgicalinstrument, and transmitting a second video stream, captured by a secondvideo camera in the operating room, of the at least one surgicalinstrument during the surgical procedure.

Transmitting the first video stream and the second video stream may beperformed in real-time.

The method may also include displaying, on a display in the operatingroom, the second video stream, annotating, with an input deviceconnected to the display, the second video stream with at least oneannotation; and transmitting the at least one annotation overlaid on thesecond video stream.

The operating room and the remote device may be located in the samecountry or different countries.

The first video stream may include an extracorporeal view of the surgeonand at least a portion of the patient, and the second video stream mayinclude an intracorporeal view of the surgical instrument inside thepatient.

The present disclosure is also directed to various embodiments of asystem for teaching a surgical procedure. In one embodiment, the systemincludes a first video camera in operating room configured to captureextracorporeal video of a surgeon performing the surgical procedure withat least one surgical instrument in the operating room, a second videocamera in the operating room configured to capture intracorporeal videoof the at least one surgical instrument inside the patient during thesurgical procedure, a display in the operating room configured todisplay at least the intracorporeal video, an input device connected tothe display, the input device configured to generate annotationsoverlaid on the intracorporeal video, and a network adapter configuredto transmit the extracorporeal video of the surgeon, the intracorporealvideo of the at least one surgical instrument, and the annotationsoverlaid on the intracorporeal video to a site remote from the operatingroom.

The system may also include a speaker connected to the network adapterin the operating room configured to generate audio in the operating roomcaptured from the site remote, and a microphone connected to the networkadapter in the operating room configured to transmit audio captured bythe microphone to the remote site.

The input device may be a mouse, a stylus, a keyboard, a touch screen,or combinations thereof.

This summary is provided to introduce a selection of features andconcepts of embodiments of the present disclosure that are furtherdescribed below in the detailed description. This summary is notintended to identify key or essential features of the claimed subjectmatter, nor is it intended to be used in limiting the scope of theclaimed subject matter. One or more of the described features may becombined with one or more other described features to provide a workabledevice.

BRIEF DESCRIPTION OF THE DRAWINGS

The features and advantages of embodiments of the present disclosurewill become more apparent by reference to the following detaileddescription when considered in conjunction with the following drawings.In the drawings, like reference numerals are used throughout the figuresto reference like features and components. The figures are notnecessarily drawn to scale.

FIG. 1 is a schematic block diagram of a system for teaching a medicalprocedure according to one embodiment of the present disclosure;

FIG. 2 is a flowchart illustrating tasks of a method of teaching amedical procedure according to one embodiment of the present disclosure;and

FIGS. 3A-3B illustrate videos transmitted according to one or moreembodiments of the systems and methods of the present disclosure.

DETAILED DESCRIPTION

The present disclosure is directed to various embodiments of systems andmethods for teaching a surgical procedure (e.g., a surgical operation,such as arthroscopic shoulder surgery) to one or more users locatedremote from the medical facility in which the surgical procedure isbeing performed. The systems and methods of the present disclosureinclude the transmission of live video of the surgical procedure on thepatient, the medical professional, and surgical instruments utilized inthe surgical procedure, as well as annotations such as text and/orgraphics overlaid on one or more of the live videos, to the one or moreremote users. The annotated live videos enable the medical personnel toteach various surgical procedures by, for example, highlighting certainanatomical structures at the surgical site, identifying various medicalequipment utilized during the procedure, and/or explaining varioustechniques utilized during the surgical procedure. The systems andmethods according to one or more embodiments of the present disclosurealso include receiving audio from the one or more remote users andtransmitting audio from the medical professional to the remote users,which enables the medical professional to converse with the remote usersduring the surgical procedure to answer questions posed by the remoteuser and to explain various techniques and/or equipment being utilizedin the surgical procedure. Teaching surgical procedures to remote usersutilizing the systems and methods of the present disclosure enablesadoption of these surgical procedures on a global scale, including indeveloping nations that might otherwise adopt less efficacious treatmentoptions.

FIG. 1 is a block diagram of a system 100 according to one embodiment ofthe present disclosure for teaching a surgical procedure to one or moreremotely located individuals. In the illustrated embodiment, the system100 includes a medical site system 200 configured to communicate with aremote site system 300 over a network 400. The network 400 may be awired network or a wireless network depending, for instance, on thedesired network reliability and/or the desired network connection speedbetween the medical site system 200 and the remote site system 300. Themedical site system 200 is located in a medical facility where a medicalprofessional will perform a surgical procedure on a patient, and theremote site system 300 is located where an individual (e.g., a traineeand/or other observers) will remotely observe the surgical procedure. Inone or more embodiments, the remote site system 300 may be located in adeveloping country, such as Haiti, Cuba, or Romania, that historicallylacked access to specialized medical equipment and/or medical trainingresources. Accordingly, in one or more embodiments, the medical sitesystem 200 may be located domestically (e.g., in the United States) andthe remote site system 300 may be located internationally (e.g., in aforeign country outside the United States). However, in one or moreembodiments, the remote site system 300 may be located in the samecountry as the medical site system 200 (e.g., the remote site system 300and the medical site system 200 may both be located domestically, suchas in the United States).

In the illustrated embodiment, the medical site system 200 includes afirst video camera 201, a second video camera 202, a display 203, amemory device 204 (e.g., persistent memory such as NAND flash memory), aprocessor 205, a video capture card 206, a network adapter 207, aspeaker 208, a microphone 209, and an input device 210. In theillustrated embodiment, the first and second video cameras 201, 202, thedisplay 203, the memory 204, the processor 205, the video capture card206, the network adapter 207, the speaker 208, the microphone 209, andthe input device 210 may communicate with each other over a system bus211. In one or more embodiments, the memory 204, the processor 205, thevideo capture card 206, and the network adapter 207 may be embodied in acomputer. In one or more embodiments, the memory 204, the processor 205,the video capture card 206, the network adapter 207, the first videocamera 201, the display 203, the speaker 208, and the microphone 209 maybe embodied in a computer.

The term “processor” is used herein to include any combination ofhardware, firmware, and software, employed to process data or digitalsignals. The hardware of a processor may include, for example,application specific integrated circuits (ASICs), general purpose orspecial purpose central processors (CPUs), digital signal processors(DSPs), graphics processors (GPUs), and programmable logic devices suchas field programmable gate arrays (FPGAs). In a processor, as usedherein, each function is performed either by hardware configured, i.e.,hard-wired, to perform that function, or by more general purposehardware, such as a CPU, configured to execute instructions stored in anon-transitory storage medium. A processor may be fabricated on a singleprinted wiring board (PWB) or distributed over several interconnectedPWBs. A processor may contain other processors; for example a processormay include two processors, an FPGA and a CPU, interconnected on a PWB.

In the illustrated embodiment, the remote site system 300 includes adisplay 301, a memory device 302 (e.g., persistent memory such as NANDflash memory), a processor 303, and a network adapter 304. In one ormore embodiments, the remote site system 300 may also include a videocamera 305, a speaker 306, a microphone 307, and an input device 308. Inthe illustrated embodiment, the display 301, the memory 302, theprocessor 303, the network adapter 304, the video camera 305, thespeaker 306, the microphone 307, and the input device 308 maycommunicate with each other over a system bus 309. In one or moreembodiments, the display 301, the memory 302, the processor 303, thenetwork adapter 304, the video camera 305, the speaker 306, themicrophone 307, and the input device 308 may be embodied in a computer.

The first video camera 201 of the medical site system 200 is positionedin the medical facility (e.g., an operating room at a hospital) suchthat the first video camera 201 is configured to capture real-time videoof the medical professional performing a surgical procedure on thepatient (e.g., the first video camera 201 is configured to capturereal-time video of a surgeon performing surgery on the patient). In oneembodiment, the first video camera 201 is configured to capture anexterior view of the medical professional and the patient (e.g., anexterior view of the arthroscopic surgeon and an exterior view of thepatient's shoulder). Accordingly, in one or more embodiments, the firstvideo camera 201 is configured (e.g., located) to capture extracorporealvideo of the patient and the surgeon.

The second video camera 202 is configured to capture video of one ormore medical instruments being utilized by the medical professionalduring the medical procedure. In one or more embodiments, depending onthe nature of the medical procedure, the second video camera 202 may beconfigured to capture video inside the patient. That is, in one or moreembodiments, the second video camera 202 is configured (e.g., located)to capture intracorporeal video of the patient at the site where the oneor more medical instruments are being utilized by a medical professionalduring a medical procedure. For instance, in one or more embodiments inwhich the medical procedure being performed and taught is arthroscopicshoulder surgery, the second video camera 202 may be a surgical videocamera inserted into the patient's shoulder proximate to the surgicalsite to capture live intracorporeal video of one or more of the surgicalinstruments utilized by the surgeon during the shoulder arthroscopy,such as suture anchors, a switching stick, cannula-trocar sets, a labralprobe, a crochet hook, a knot pusher, tissue elevators, glenoid rasps,and/or a suture retriever.

The output (e.g., video stream) of the first video camera 201 and theoutput (e.g., video stream) of the second video camera 202 are eachconnected to the display 203 such that the display 203 of the medicalsite system 200 is configured to display the video captured by the firstvideo camera 201 and the video captured by the second video camera 202.In the illustrated embodiment, the output of the second video camera 202is connected to the display 203 via the video capture card 206, whichenables the transmission of analog video captured from the second videocamera 202 through a digital platform. In one or more embodiments, thesystem 200 is configured to display the video (e.g., the extracorporealvideo stream) of the medical professional and the patient captured bythe first video camera 201 synchronously or substantially synchronouslywith the video (e.g., the intracorporeal video stream) of the one ormore surgical instruments captured by the second video camera 202. Inone or more embodiments, the system 200 is configured to display, on thedisplay 203, the video (e.g., the extracorporeal video stream) of themedical professional and the patient captured by the first video camera201 and the video (e.g., the intracorporeal video stream) of the one ormore surgical instruments captured by the second video camera 202 inreal-time or substantially in real-time.

With continued reference to the embodiment illustrated in FIG. 1, theinput device 210 is configured to enable a user to annotate the videocaptured by the first video camera 201 and/or annotate the videocaptured by the second video camera 202. The input device 210 may enableany suitable type or kind of annotations, such as, for instance,graphics (e.g., arrows or an oval) and text (e.g., words indicatingvarious anatomical features of the patient, such as the head of thehumerus, and/or the surgical technique being performed by the surgeon).The input device 210 may be any suitable type or kind of electronicdevice, such as, for instance, a mouse, a stylus, a keyboard, and/or atouch screen (i.e., a touch sensitive display).

The system 100 of the present disclosure also includes a videoconferencing platform configured to enable the transmission of videoand/or audio between the medical site system 200 and the remote sitesystem 300. The video conferencing platform is accessible by both themedical site system 200 and the remote site system 300. In one or moreembodiments, the video conferencing platform may be stored locally onthe memory 204 of the medical site system 200 and the memory 302 of theremote site system 300, or the video conferencing platform may be storedon a remote server (i.e., the video conferencing server may be hosted inthe “cloud”) accessible by network adapters 207 and 304 of the medicalsite system 200 and the remote site system 300, respectively. The videoconferencing platform is a software program that includes instructions,which, when executed by a processor, cause the processor to performvarious functions. In one or more embodiments, the instructions causethe processor to read and/or write data to and from the memory, and tosend commands to, and receive data from, various other components of thesystem, including the first camera, the second camera, the display, andthe network adapter.

In one embodiment, the video conferencing platform has instructionsstored therein, which, when executed by the processor 205 of the medicalsite system 200, cause the display 203 of the medical site system 200 todisplay the video of the medical professional and the patient capturedby the first video camera 201 and to display the video of the one ormore surgical instruments utilized in the surgical procedure captured bythe second video camera 202. In one or more embodiments, the video ofthe medical professional and the patient and the video of the one ormore surgical instruments may be displayed in separate windows on thesame display 203, the video of the medical professional and the patientand the video of the one or more surgical instruments may be displayedin the same window on the same display 203, or the video of the medicalprofessional and the patient and the video of the one or more surgicalinstruments may be displayed on separate displays 203.

The video conferencing platform includes instructions therein, which,when executed by the processor 205 of the medical site system 200, causethe processor 205 to overlay the annotations, input via the input device210, on the video captured by the first video camera 201 and/or thesecond video camera 202 and to display the videos with the overlaidannotations on the display 203.

The video conferencing platform also includes instructions therein,which, when executed by the processor 205 of the medical site system200, cause the medical site system 200 to transmit, via the networkadapter 207, the videos captured by the first and second video cameras201 and 202 with the overlaid annotations to the remote site system 300.

The video conferencing platform includes instructions therein, which,when executed by the processor 303 of the remote site system 300, causethe remote site system 300 to receive, via the network adapter 304, thevideos with the overlaid annotations transmitted by the medical sitesystem 200. The instructions of the video conferencing platform, whenexecuted by the processor 303 of the remote site system 300, also causethe display of the remote site system 300 to display the videos with theoverlaid annotations transmitted by the medical site system 200. FIG. 3Adepicts videos with overlaid annotations (e.g., an arrow) transmitted bythe medical site system and displayed on the display 301 of the remotesite system 300 according to one embodiment of the present disclosure,and FIG. 3B depicts videos without overlaid annotations transmitted bythe medical site system and displayed on the display 301 of the remotesite system 300 according to one embodiment of the present disclosure.

In one embodiment, the video conferencing platform also includesinstructions, which, when executed by the processor 205 of medical sitesystem 200, cause the microphone 209 in the medical facility to captureaudio from the medical professional performing the surgical procedureand/or other medical personnel in the medical facility (e.g., medicalpersonnel in the operating room), and to transmit the captured audio tothe remote site system 300 via the network adapter 207.

In one embodiment, the video conferencing platform also includesinstructions, which, when executed by the processor 303 of remote sitesystem 300, cause the remote site system 300 to receive, via the networkadapter 304, the audio transmitted by the medical site system 200 andcause the speaker 306 at the remote site to play the audio received fromthe medical site system 200.

In one or more embodiments, the video conferencing platform alsoincludes instructions, which, when executed by the processor 303 ofremote site system 300, cause the microphone 307 and the video camera305 of the remote site system 300 to capture audio and video of the oneor more remote users, and to transmit, via the network adapter 304, thecaptured audio and video to the medical site system 200.

The input device 308 of the remote site system 300 enables a user toinput annotations on the videos captured by the first and second videocameras 201 and 202 that were transmitted to the remote site system 300by the medical site system 200. In one or more embodiments, the videoconferencing platform also includes instructions, which, when executedby the processor 303 of remote site system 300, cause the remote sitesystem 300 to transmit, via the network adapter 304, the annotations tothe medical site system 200.

In the illustrated embodiment, the video conferencing platform includesinstructions, which, when executed by the processor 205 of the medicalsite system 200, cause the medical site system 200 to receive, via thenetwork adapter 207, the audio and video of the one or more remote userstransmitted by the remote site system 300, cause the speaker 306 in themedical facility to play audio captured by the microphone 307 of theremote site system 300, cause the display 203 in the medical facility todisplay the video captured by the video camera 305 of the remote sitesystem 300, and/or cause the display 203 in the medical facility todisplay the annotations input by the input device 308 of the remote sitesystem 300.

FIG. 2 is a flowchart illustrating tasks of a method 500 of teaching asurgical procedure to one or more remotely located individuals accordingto one embodiment of the present disclosure. In the illustratedembodiment, the method 500 includes a task 510 of capturing a video(e.g., an extracorporeal video stream) of a patient and a medicalprofessional (e.g., a surgeon) performing a surgical procedure on thepatient with at least one surgical instrument. In one or moreembodiments, the video may be captured with a first video camera locatedin a medical facility (e.g., an operating room).

In the illustrate embodiment, the method 500 also includes a task 520 ofcapturing a video of the one or more surgical instruments duringperformance of the surgical procedure by the medical professional on thepatient. In one or more embodiments, the video may show a surgicalinstrument being utilized to perform a surgical operation inside thepatient (e.g., arthroscopic repair of a patient's rotator cuff). Thatis, in one or more embodiments, the video captured in task 520 may beintracorporeal video of the patient at the site where the one or moremedical instruments are being utilized by a medical professional duringa medical procedure. In one or more embodiments, the video of thesurgical instrument may be captured with a second video camera (e.g., asurgical video camera) inside the patient proximate to the surgicalsite.

In the illustrated embodiment, the method 500 also includes a task 530of displaying the video of the medical professional and the patientcaptured during task 510, and displaying the video of the one or moresurgical instruments being utilized in the surgical procedure capturedduring task 520, on one or more displays located in the medical facility(e.g., the operating room) in which the surgical procedure is beingperformed. In one or more embodiments, the video of the medicalprofessional and the patient and the video of the one or more surgicalinstruments may be displayed in separate windows on the same display,the video of the medical professional and the patient and the video ofthe one or more surgical instruments may be displayed in the same windowon the same display, or the video of the medical professional and thepatient and the video of the one or more surgical instruments may bedisplayed on separate displays. In one or more embodiments, the task 530includes displaying the video of the medical professional and thepatient and the video of the one or more surgical instrumentssynchronously or substantially synchronously. In one or moreembodiments, the video of the medical professional and the patient andthe video of the one or more surgical instruments displayed in task 530may both be displayed on the display in real-time or substantially inreal-time. In one or more embodiments, the display on which the videosof the medical professional, the patient, and the surgical instrumentare displayed in task 530 may be a monitor of a computer, and thecomputer may be electrically connected to the first video camera and thesecond video camera (e.g., the surgical video camera) by a video capturecard of the computer.

In the illustrated embodiment, the method 500 also includes a task 540of annotating the video of the surgical instrument and/or annotating thevideo of the patient and the medical professional. The task 540 ofannotating the video may be performed by an individual distinct from themedical professional performing the surgical procedure on the patient(e.g., the task 540 of annotating the video may be performed by amedical assistant, such as a surgical technician, in the operatingroom). In one or more embodiments, the network connected computer onwhich videos are displayed may be operating a video conferencingplatform, and the task 540 of annotating the video may be performed byan individual interfacing with the video conferencing platform. In oneor more embodiments, the video conferencing platform may be storedlocally on memory of the computer or the video conferencing platform maybe stored on a remote server (i.e., the video conferencing server may behosted in the “cloud”) accessible by the network connected computer inthe medical facility (e.g., the operating room). The annotations mayinclude text and/or graphic symbols. For instance, the task 540 ofannotating the video may include inputting text and/or symbols (e.g., anarrow or an oval) identifying various anatomical features of the patient(e.g., identifying one or more muscles, tendons, or bones of the rotatorcuff, such as the head of the humerus). The task 540 of annotating thevideo may be performed utilizing any suitable input device, such as amouse, a stylus, a keyboard, and/or a touchscreen (i.e., a touchsensitive display), connected to the computer in the medical facility(e.g., the operating room).

In the illustrated embodiment, the method 500 also includes a task 550of transmitting, over a network, the video of the medical professionaland the patient and the video of the surgical instrument, together withthe overlaid annotations, to the one or more remote users. The task 550of transmitting the videos and the overlaid annotations may be performedby the video capture card and a network adapter of the computer. Thetask of transmitting the videos and the overlaid annotations may beperformed over a wired network or a wireless network depending, forinstance, on the desired network reliability and/or the desired networkconnection speed between the medical facility and the system operated bythe one or more remote users. In one or more embodiments, the task 550of transmitting the video of the medical professional and the patientand the video of the medical instrument, together with the overlaidannotations, may be performed in real-time or substantially in real-timewith the performance of the surgical procedure on the patient.

In the illustrated embodiment, the method 500 also includes a task 560of transmitting audio from the medical professional performing thesurgical procedure and/or one or more medical assistants at the medicalfacility (e.g., medical personnel in the operating room) to the one ormore remote users. The audio transmitted during task 560 may be capturedby a microphone located in the medical facility (e.g., the operatingroom) and the audio may be transmitted to the remote users with thenetwork adapter of the computer in the medical facility.

In the illustrated embodiment, the method 500 also includes a task 570of displaying the video of the patient and the medical professional andthe video of the surgical instrument, together with the overlaidannotations, on a remote display (e.g., a computer monitor remote fromthe medical facility) that the one or more remote users can view. In oneembodiment, the video of the patient and the medical professional andthe video of the surgical instrument may be displayed in separatewindows on the display visible to the one or more remote users.

Additionally, in the illustrated embodiment, the method includes a task580 of playing the audio, transmitted at task 560, from a remote speaker(e.g., a computer speaker remote from the medical facility) that the oneor more remote users can hear.

In the illustrated embodiment, the method 500 also includes tasks 590 oftransmitting audio and video of the one or more remote users (e.g., thetrainees), captured by a microphone and a video at a remote site, to themedical facility and playing the audio and the video of the one or moreremote individuals via a speaker and a display in the medical facility(e.g., the operating room) in which surgical procedure is beingperformed. In one or more embodiments, the tasks 590 may includetransmitting annotations input by an input device (e.g., a mouse, akeyboard, a stylus, and/or a touchscreen) at the remote site to themedical facility, and displaying the annotations on the display in themedical facility. In one or more embodiments, the annotations displayedin task 590 may be overlaid over the video of the medical professionaland the patient and/or the video of the one or more surgicalinstruments, which are displayed on the display in the medical facilityin task 530. In this manner, the one or more individuals (e.g.,trainees) at the remote site may communicate questions or commentsverbally and/or graphically to the one or more medical professionals atthe medical facility in which the surgical procedure is being performed.

While this invention has been described in detail with particularreferences to exemplary embodiments thereof, the exemplary embodimentsdescribed herein are not intended to be exhaustive or to limit the scopeof the invention to the exact forms disclosed. Persons skilled in theart and technology to which this invention pertains will appreciate thatalterations and changes in the described structures and methods ofassembly and operation can be practiced without meaningfully departingfrom the principles, spirit, and scope of this invention, andequivalents thereof.

What is claimed is:
 1. A method of teaching a surgical procedure, themethod comprising: transmitting a first video, from a first location toa second location remote from the first location, of a surgeon in anoperating room performing the surgical procedure on a patient with atleast one surgical instrument; transmitting a second video, from thefirst location to the second location, of the surgical instrument duringthe surgical procedure; annotating the second video with at least oneannotation; and transmitting, from the first location to the secondlocation, the at least one annotation overlaid on the second video. 2.The method of claim 1, wherein the first video is an extracorporealvideo of the surgeon and at least a portion of the patient, and whereinthe second video is an intracorporeal video of the surgical instrumentinside the patient.
 3. The method of claim 1, wherein the transmittingthe first video, the transmitting the second video, and the transmittingthe at least one annotation overlaid on the second video are performedby transmitting a single video stream comprising the first video, thesecond video, and the at least one annotation overlaid on the secondvideo.
 4. The method of claim 1, further comprising displaying thesecond video on a display in the operating room.
 5. The method of claim4, further comprising displaying on the display in the operating room atleast one annotation transmitted from the second location.
 6. The methodof claim 4, wherein the annotating the second video is performed with aninput device connected to the display, the input device being selectedfrom the group of devices consisting of a mouse, a stylus, a keyboard, atouch screen, and combinations thereof.
 7. The method of claim 6,wherein the at least one annotation is selected from the group ofannotations consisting of a shape, a symbol, a graphic, text, andcombinations thereof.
 8. The method of claim 1, further comprisingtransmitting, from the first location to the second location, audiocaptured by a microphone in the operating room.
 9. The method of claim1, further comprising generating audio, from a speaker in the operatingroom, captured by a microphone at the second location.
 10. The method ofclaim 1, wherein the transmitting the first video is performedsynchronously with the transmitting the second video.
 11. The method ofclaim 10, wherein the transmitting the first video and the transmittingthe second video are performed in real-time.
 12. The method of claim 1,wherein the annotating the second video is performed by an individualother than the surgeon.
 13. A method of teaching a surgical procedure,the method comprising: transmitting a first video stream, captured by afirst video camera in an operating room, of a surgeon performing thesurgical procedure with a least one surgical instrument; andtransmitting a second video stream, captured by a second video camera inthe operating room, of the at least one surgical instrument during thesurgical procedure.
 14. The method of claim 13, wherein the transmittingthe first video stream and the transmitting the second video stream areperformed in real-time.
 15. The method of claim 13, further comprising:displaying, on a display in the operating room, the second video stream;annotating, with an input device connected to the display, the secondvideo stream with at least one annotation; and transmitting the at leastone annotation overlaid on the second video stream.
 16. The method ofclaim 13, wherein the operating room and the remote device are locatedin the same country or different countries.
 17. The method of claim 13,wherein the first video stream comprises an extracorporeal view of thesurgeon and at least a portion of the patient, and wherein the secondvideo stream comprises an intracorporeal view of the surgical instrumentinside the patient.
 18. A system for teaching a surgical procedure, thesystem comprising: a first video camera in operating room configured tocapture extracorporeal video of a surgeon performing the surgicalprocedure with at least one surgical instrument in the operating room; asecond video camera in the operating room configured to captureintracorporeal video of the at least one surgical instrument inside thepatient during the surgical procedure; a display in the operating roomconfigured to display at least the intracorporeal video; an input deviceconnected to the display, the input device configured to generateannotations overlaid on the intracorporeal video; and a network adapterconfigured to transmit the extracorporeal video of the surgeon, theintracorporeal video of the at least one surgical instrument, and theannotations overlaid on the intracorporeal video to a site remote fromthe operating room.
 19. The system of claim 18, further comprising: aspeaker connected to the network adapter in the operating room, thespeaker configured to generate audio in the operating room captured fromthe site remote; and a microphone connected to the network adapter inthe operating room, wherein the network adapter is configured totransmit audio captured by the microphone to the remote site.
 20. Thesystem of claim 18, wherein the input device is selected from the groupof devices consisting of a mouse, a stylus, a keyboard, a touch screen,and combinations thereof.